Provider Demographics
NPI:1508190265
Name:FLEMING, WILLIE CLARENCE (PHD,LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:CLARENCE
Last Name:FLEMING
Suffix:
Gender:M
Credentials:PHD,LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 LORETTA PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-9716
Mailing Address - Country:US
Mailing Address - Phone:704-563-6158
Mailing Address - Fax:
Practice Address - Street 1:1973 JN PEASE PL
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4547
Practice Address - Country:US
Practice Address - Phone:704-548-5299
Practice Address - Fax:704-548-5292
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7401101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional